Navigator organizations fight concerns about fraud, lack of training

With final details for state insurance exchanges still in the works, organizations are starting to hire people to help consumers through the enrollment process that will begin on Oct. 1. They're doing so while fending off concerns of conflicts of interest, shoddy training and the potential for fraud.

The Patient Protection and Affordable Care Act establishes grant funding for guides who will, for example, educate consumers on ways to apply for tax credits and subsidies. They may not steer them to particular plans.

Some lawmakers and industry stakeholders—particularly insurance brokers—have raised concerns that the navigators and assisters will lack appropriate training and that HHS' proposed regulations on their roles don't adequately protect consumers from conflicts of interest and misuse of private data, such as Social Security numbers.

Six Maryland organizations—Calvert Healthcare Solutions, HealthCare Access Maryland, Healthy Howard, Montgomery County Department of Health & Human Services, Seedco and Worcester Co. Health Department—say those fears are misplaced.

In April, the Maryland Health Benefit Exchange launched its Connector program and named those organizations to share in $24 million in grant funding to hire navigators and consumer assisters.

HealthCare Access Maryland, for example, will hire 107 navigators and assisters in its coverage area that includes Baltimore and a surrounding county to its south. Meanwhile, Seedco will hire 25 navigators and assisters for the upper eastern shore region of the state.

Stephanie Shirey, director of operations at Healthy Howard, said the Maryland exchange mandates that they get 120 hours of training. She added that the exchange has safeguards in place, thus preventing nefarious activity by workers.

The state's request-for-proposal process called for extensive vetting of employees, said Michael Shaw, executive director of Calvert Healthcare Solutions.

The Maryland organizations also disputed the notion that the new guides will encroach on territory better handled by insurance brokers. Navigators will in fact complement the work of brokers and agents, said Lisa Stein, vice president, work and family supports, for Seedco.

Navigators will be equipped to help people who “have more barriers, lower health literacy and require more one-on-one attention than perhaps a traditional insurance agent may have the time for,” Stein said. “People need to understand that consumers are going to be empowered to make (health plan) decisions and we will make sure that happens.”

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